Provider Demographics
NPI:1285613208
Name:CHAVES, FERNANDO G (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:G
Last Name:CHAVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6609
Mailing Address - Country:US
Mailing Address - Phone:330-393-5864
Mailing Address - Fax:330-393-9921
Practice Address - Street 1:1421 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6609
Practice Address - Country:US
Practice Address - Phone:330-393-5864
Practice Address - Fax:330-393-9921
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053577207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672928Medicaid
OHP00060248OtherRAILROAD MEDICARE
OHP00060248OtherRAILROAD MEDICARE
OH0589813Medicare PIN